Civil Defense Perspectives vol. 35 #2
The rationale for draconian, destructive measures to “slow the spread” of SARS-CoV-2, the dreaded “novel” coronavirus, is that the disease is untreatable. The Infectious Diseases Society of America, (IDSA, idsociety.org) provides no guidance for home treatment, and many if not most physicians send patients away, advising them to go to the emergency room if extremely ill and probably in need of hospitalization.
In a Jul 8 statement, unchanged as of Sep 8, IDSA implores the public to “take the only simple and effective steps we have to slow the spread of the coronavirus and save lives—key among them, wear a mask…. We are all in the fight against this pandemic together. As infectious diseases and HIV specialists responding to the continuing impacts of COVID-19, we call on all people to do their part to end this public health crisis.”
(Parenthetically, IDSA not only declines to treat chronic Lyme disease, but denies its existence and tries to prevent others from treating it also.)
Once in the hospital, a patient might be enrolled in a clinical trial. More than 3,000 federally-funded trials related to COVID-19 are listed at clinicaltrials.gov. A drug, generally expensive and not suitable for home use, will be compared with “standard treatment.” The latter is not well-defined, but would include fluids, management of other conditions, and oxygen, by mechanical ventilation if needed. The patient will be virtually a prisoner, deprived of visits by family, clergy, or independent physicians. Treatment will be prescribed by hospitalists or specialists controlled by the hospital, generally a giant corporate entity. Options will be limited: the patient may consent to a trial, or decline treatment or resuscitation, but might be assigned an automatic DNR (do not resuscitate) status.
One consequence of locking down hospitals, to prevent spread of COVID, is that outsiders do not know what is going on there. There are no community-based physicians chatting in the doctors’ lounge or having lunch together at a weekly educational conference. (Such interactions were already much diminished with the rise of the corporate practice of medicine—few nonspecialists have retained their hospital privileges.) Is the shocking video by the undercover Elmhurst Hospital travel nurse (https://tinyurl.com/ya549vt8) genuine, or an anomaly?
Staying out of the hospital is critical.
Old Treatments: a Great Awakening?
There are no blockbuster new drugs to specifically treat the “novel” coronavirus—or its cousins, which cause the common cold, SARS (severe acute respiratory syndrome), and MERS (Middle East respiratory syndrome). The prospect for immediate treatment is from re-purposing older, already approved methods.
Early observational results show we should seize the opportunity to reevaluate our treatment—or nontreatment—of all viral illnesses. Doctors have been telling their patients for decades that antimicrobials, especially antibiotics, don’t help viral infections. If they prescribe something, it is “just in case of a bacterial superinfection.” But when investigating reports about the use of the antimalarial hydroxychloroquine for COVID-19, Lee Merritt, M.D., found 20 scientific papers, written in the last 40 years, on the use of lysosomotropic agents—specifically chloroquine—to treat viruses. “Like Rip Van Winkle, I suddenly awoke, after decades, to a completely new medical reality” (tinyurl.com/y2o37t78).
Specific antiviral drugs are few, and resistance develops rapidly (tinyurl.com/yyjalwp4). They work by preventing the virus from attaching to the host cell, or from penetrating and uncoating, or from budding and releasing new virions. Or they may block host enzymes needed for viral replication—but also for the host’s own functions. Some, like remdesivir, are nucleoside analogs, which get incorporated into the viral genome by the virus’s RNA-dependent RNA polymerase. The chemical conformation of the viral target must fit the drug exactly; mutations that alter it are frequent, especially in RNA viruses.
Treatments that affect the terrain, such as the biochemical milieu or the body’s defense mechanisms, need not be so specific—and are likely unaffected by viral mutation.
The COVID-19 disease has two phases—viral replication, and the body’s potentially self-destructive inflammatory response. The re-purposed drugs work at one or both levels.
Lysosomotropic drugs such as chloroquine (CQ) and hydroxychloroquine (HCQ) are weak bases that increase the pH in acidic cellular organelles, decreasing the ability of some viruses to enter cells and propagate. CQ and HCQ are also zinc ionophores—they facilitate the entry of the zinc ion into cells, where it directly inhibits viral replication. Zinc is involved in cell-mediated immunity against any infectious agent, and also mediates protection from the adverse effect of reactive oxygen species (ROS) that are generally produced during inflammatory processes (https://tinyurl.com/y6kxvpeg). Almost all patients with severe COVID in a Japanese study had low Zn levels, <70 mcg/dL (https://tinyurl.com/y3z4ul6m).
CQ and HCQ can also act on the immune system through cell signaling and regulation of pro-inflammatory cytokines (tinyurl.com/y2j4zglx) and help quell a cytokine storm.
In cell culture, CQ has antiviral activity against many viruses, including rabies, hepatitis, dengue, influenza, Zika, and Ebola. The effect has not always been confirmed in clinical trials.
A number of antibiotics—tetracyclines, macrolides, metronidazole, and ciprofloxacin—have been shown in the laboratory to have antiviral effects against many viruses (tinyurl.com/yyqltgbx).
The War on Hydroxychloroquine
As soon as some physicians began to prescribe HCQ, and President Trump called it a potential game-changer and asked “What have you got to lose?”, AMA’s then-president Patrice Harris responded, “Possibly your life.” We needed to “follow the science” and wait for the “gold standard” of randomized controlled trials (RCTs). We needed to save supplies of this [terribly dangerous?] drug for the millions already safely taking it for autoimmune conditions. And U.S. pharmacies and wholesalers began to restrict it. It took Science one day to reject a letter from African scientists of many nations concerning their successful HCQ use, which noted that RCTs are not relevant for urgent public health issues (https://tinyurl.com/y37hd4uu).
Is there a war against humanity?
Hydroxychloroquine Evidence
As of Sep 14, there are 101 studies on HCQ, 59 peer-reviewed, summarized at c19study.com. Of these, 89% show efficacy for pre-exposure prophylaxis, 100% for post-exposure prophylaxis, 100% for early treatment, and 62% for late treatment. A country-based analysis, posted at hcqtrial.com, shows that countries that adopted early HCQ had a 75% lower mortality than countries that declined it, while accounting for many confounding variables. A systematic review is at tinyurl.com/y66guqe6. The Association of American Physicians and Surgeons (AAPS) is curating relevant articles on HCQ and other COVID issues at bit.ly/coronavirusarticles. This includes state restrictions on HCQ (tinyurl.com/y7oc65gn). Also see U.S. and world map at https://americasfrontlinedoctorsummit.com/hcq/.
Vitamin D3 as Treatment
Social media giants may censor information on vitamins in COVID-19 as “harmful misinformation,” but now Dr. Anthony Fauci has said: “If you’re deficient in vitamin D, that does have an impact on your susceptibility to infection. I would not mind recommending, and I do it myself, taking vitamin D supplements…. The other vitamin that people take is vitamin C because it’s a good antioxidant, so if people want to take a gram or so of vitamin C, that would be fine (https://tinyurl.com/yyjk6fhq). He did not say what dose of vitamin D he takes.
Vitamin D is necessary for immunity, especially for respiratory viruses (tinyurl.com/y6l5thce), and now a randomized, controlled Spanish study (https://tinyurl.com/yxmqdj3l) reports that high doses used therapeutically significantly reduced the need for intensive care. Of 50 treated patients, one (2%) required ICU admission, and of 26 untreated patients, 13 (50%) did (p<.001). The number of deaths was zero and two, respectively.
The dosage regimen was 0.532 mg (about 20,000 IU) orally of calcifediol on admission, then 0.266 mg on days 3 and 7 and weekly until discharge. Calcifidiol (calcidiol, 25-hydroxycholecalciferol, or 25-hydroxyvitamin D) is a prehormone that is produced in the liver by hydroxylation of vitamin D3 (cholecalciferol), which is then converted in the kidneys into calcitriol (1,25-(OH)2D3), the active form of vitamin D.
All patients received HCQ and azithromycin.
Retired cardiac surgeon Donald Miller, M.D., writes that doctors in India and Canada give people a once-yearly injection of 600,000 IU of vitamin D, and suggests that this might be better, and safer, than having a flu shot.
The FDA-recommended daily allowance of vitamin D, 600 IU for adults, 800 IU at age over 70, is generally inadequate to maintain optimal blood levels. Concerns about vitamin D toxicity are overblown, Dr. Miller states (https://tinyurl.com/yxsjh6fj). In healthy persons, long-term consumption of more than 40,000 IU a day is necessary to cause an elevation in the blood calcium level (hypercalcemia), the first manifestation of vitamin D toxicity (Am J Clin Nutr 2006;84:694-697). To maintain a year-round vitamin D blood levels greater than 50 ng/ml, most people need to take 4,000–5,000 IU of vitamin D3 a day (or 50,000 IU every ten days or 150,000 IU a month).
In a review of the myriad beneficial effects of vitamin D, the late Joel Kauffman, Ph.D., noted that the drop in all-cause mortality was far better for subjects in a vitamin D trial than in a statin drug trial (https://tinyurl.com/y6rlwazm).
Other Promising Drugs
Ivermectin, an antiparasitic drug in widespread use in human and veterinary medicine since 1981, has been associated with rapid resolution in some cases of severe COVID-19 at a dose of 9 mg. Based on in vitro studies, this is probably too low a dose to inhibit viral replication, so the drug was probably acting as an anti-inflammatory in these cases (tinyurl.com/y3y3fous). Ivermectin has antiviral activity against a number of other viruses as well (https://tinyurl.com/yxwgt23m).
· Many COVID symptoms could be explained by excess bradykinin. Drugs that could potentially mitigate a bradykinin storm include danazol and stanozolol (tinyurl.com/y4dwlvbx).
The MATH+ (methylprednisolone, ascorbic acid, thiamine, heparin, and possibly other agents) protocol was developed at the Eastern Virginia Medical School (https://tinyurl.com/vytf3ye).
Aviptadil (synthetic vasoactive intestinal polypeptide, VIP), has been associated with rapid recovery from respiratory failure in patients on ventilators or extracorporeal membrane oxygenation (ECMO) (https://tinyurl.com/y4kylu3p).
Nitazoxanide, an antiparasitic drug used to treat Cryptosporidium parvum or Giardia lamblia, is also a broad-spectrum antiviral being used for COVID in Brazil (tinyurl.com/yypuc4n9).
The expectorant cough suppressant bromhexine, an over-the-counter drug in many places but unavailable in the U.S., reduced deaths by 100% and ICU need by 82% in a study of 78 patients in Iran. It blocks entry of SARS-CoV-2 via the ACE2 receptor. It might be useful both for prophylaxis and treatment (https://tinyurl.com/y4eaefon).
Hydrogen peroxide and ozone are “alternative” therapies, given with reportedly good results together with vitamins A, C, D, and potassium iodide (Lugol’s solution). Peroxide was administered by nebulizer or intravenously, or ozone by intramuscular injection. Brownstein et al. note that mortality from influenza and pneumonia was reduced from 80% to 48% in Indian troops treated with IV peroxide by T.H. Oliver in 1920. In 2014, all five Ebola patients treated with ozone recovered (https://tinyurl.com/y2bml8qm).
Convalescent plasma to induce passive immunity from borrowed antibodies is a 100-year-old idea that should be as safe as blood transfusion. Interest waned with the advent of antibiotics.
AeroNabs are a synthetic “antibody” that is said to “straitjacket” the coronavirus by hooking onto its spike protein, which latches onto the host cell’s ACE2 receptor, thereby gaining entry. The idea was inspired by the antibodies of some mammals (e.g. llamas and camels) called nanobodies that could potentially be engineered on an atom-by-atom basis. It is hoped that one inhaled dose of AeroNabs per day might serve both as treatment and “molecular personal protective equipment (PPE).” AeroNabs can be produced in industrial quantities at very low expense (https://tinyurl.com/y4837j25).
Intravenous vitamin C, found to have great potential in the 1950s, may be impossible to get in a hospital. A naturopath’s office might be the most likely source.
Quercetin, a plant flavonoid, in addition to being a zinc ionophor has many antiviral and immunomodulatoy effects demonstrated in vitro. There is evidence of a synergistic effect with vitamin C, and this safe, low-cost combination is likely to be of benefit in both prevention and treatment of COVID-19 and other viral illnesses (https://tinyurl.com/y3vd7te7).